Hurricane Sandy resulted in the devastation of many communities in New York. In particular, Long Island experienced major flooding and powerful winds that left many without electricity for weeks, destroyed homes, and left behind mold and other environmental toxins. One of the most vulnerable groups living in these highly affected areas is responders to the attacks on the World Trade Center (WTC) on September 11, 2001 (9/11), many of whom continue to be active responders and, have persistent respiratory and psychological problems, or both, as a result of their response to 9/11. The Stony Brook WTC Health Program provides yearly health monitoring and treatment for WTC-related conditions for 7,000 WTC responders. Each year we systematically assess physical and mental health conditions, which we have been tracking in our cohort for the past eight years. Immediately after Hurricane Sandy, we began screening for Hurricane Sandy-related exposures. WTC responders exposed to this disaster may be particularly at-risk for new or exacerbation of health problems. The overall objective of the proposed study is to evaluate levels of exposure to environmental toxins and psychological trauma as a result of Hurricane Sandy and their effects on respiratory and mental health in a sample of 550 WTC responders from highly affected areas. The specific aims are to: (1) evaluate the impact of the disaster on WTC responders by examining changes from pre to post hurricane Sandy, in respiratory symptoms, lung functioning, and PTSD and depression symptoms; (2) document exposure to environmental toxins (i.e., mold and dust) and psychological trauma, and evaluate the impact of these exposures on respiratory symptoms, lung functioning, and mental health; (3) determine whether post-Hurricane Sandy PTSD symptoms are a risk factor for post disaster respiratory symptoms and lung functioning, and if PTSD mediates the impact of toxic exposures on respiratory health. We will use multimodal assessments including self-report, structured clinical interviews, and skin and serum allergy testing. By utilizing pre-Hurricane Sandy health data, we will be able to identify risk factors for post- disaster physical and mental health problems. This study will also provide translational value by furthering our understanding how respiratory disease and PTSD interact with one another. Thus, the current investigation offers a unique scientific opportunity to learn about the sequelae of Hurricane Sandy in an at-risk population and possible avenues for intervention and prevention.